X Prize: making the Tricorder a reality

This article was taken from the February 2013
issue of Wired magazine. Be the first to read Wired's articles in
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In 1967, Star Trek featured a fictional medical
device, the Tricorder, which could diagnose a multitude
of ailments non-invasively. Now a $10 million (£6.4 million)
X Prize is fuelling a race to make the Tricorder a
reality.

Could Walter De Brouwer's Scanadu SCOUT, one of the contenders,
be the diagnostic tool that will transform how we manage our future
healthcare?

Walter De Brouwer: On his office balcony, he holds the SCOUT to his head. The bio-data is sent to his phone

Spencer Lowell

In 2005, Walter De
Brouwer carried his five-year-old son, Nelson, into
an emergency room in Brussels. The boy was
unconscious, and the left side of his head was caved in. In
medical parlance he was class three on the Glasgow Coma
Scale, a designation that carried the implication of
permanent brain damage. Nelson had fallen from a window ten metres
up. If he had not been operated on, the blood from his wound would
have exerted so much pressure that his brain might have exploded.
Medical procedures for head injuries differ around the world,
but some physicians consider operating on Glasgow-3 patients to be
pointless. The Belgian doctors agreed to operate, but with the
caveat that if Nelson survived there was a good chance that he
would be vegetative. They said his "content" might be gone.

The idea of total content loss was significant to De Brouwer: he
was a digital entrepreneur who viewed information as the most
important currency in the modern world. In his youth, as the
publisher of the Belgian cyberpunk magazine WAVE, De Brouwer had
been an anarchist; this was when proclaiming "information must be
free" sounded like dissent. By the time he founded the deep-future
research firm Starlab in 1996, the net was blossoming and
disruption had become the norm. Starlab employed the physicist
Serguei Krasnikov to research portals for time travel, and the AI
expert Hugo de Garis to develop an artificial brain. When Starlab
closed its doors in 2001, after losing some key investors, De
Brouwer took a job in finance; he was finished with big ideas.

The downside of being an information scientist is that you see
everything in terms of data. After
Nelson's surgery, De Brouwer sat with his son in the intensive care
unit (ICU) beside a series of machines that offered information to
the doctors. Then Nelson was moved to the general wards, where,
instead of machines, there were just nurses. De Brouwer became
consumed by the idea of all the data stuck inside Nelson. "When the
doctor comes in it's, like, 'Open your mouth…'" De Brouwer says
today. "Our grandchildren will laugh about this, the comedy capers
of medicine."

There was a moment -- it would not come for a few more years,
after 13 more operations for Nelson -- when De Brouwer wanted to
share this knowledge with the world. He wrote to Starlab's former
investors: "I propose doing one last big idea. If we succeed,
everything else will be a footnote. Our last legacy: to disrupt
healthcare. To destroy the hospital and clinical system and give
the tools and knowledge to the people."

De Brouwer's big idea? To build a machine to read the
information in Nelson's brain.

Singularity University is
an experiment in futurist education situated at Nasa Ames
Research Center, in the heart of Silicon Valley. Dr Peter
Diamandis, the chairman and CEO of X Prize Foundation, cofounded
Singularity with Ray Kurzweil in 2009, and he continues to use the
institution as a testing ground for bold ideas. In the summer of
2011, when De Brouwer was launching his healthcare project,
Scanadu, Singularity hosted a seminar called FutureMed, which aimed to
explore how exponential technologies can disrupt healthcare. De
Brouwer arrived at FutureMed eager to reveal a secret: Scanadu
wanted to manufacture a medical Tricorder -- a piece of hand-held
technology from the TV show Star Trek that is capable of
scanning, analysing and recording a wide array of data, including
physiological. What he didn't realise was that Diamandis wanted to
create an X Prize to encourage development of exactly such a
device.

The X Prize is renowned for targeting the cusp of what is
humanly possible, and the Tricorder certainly qualified. Placed
near a patient's body on Star Trek, it offered a complete,
non-invasive diagnosis. Like many technologies unveiled on Star
Trek, the Tricorder seeped into popular culture, a tribute
both to how well the show's creator, Gene Roddenberry, limned the
scientific expectations of his day, and to how the Tricorder
addressed a latent desire about data extraction: mining the self.
As the global healthcare industry has evolved into a morass of
expenditures and conflicting interests, the impulse of
self-diagnosis evoked by the Tricorder has come to represent the
ultimate goal for medical innovation.

Eugene Chan's Universal Blood Sensor

Spencer Lowell

In early 2012, Diamandis went public with the Qualcomm Tricorder X
Prize. Sponsored by the Qualcomm Foundation, the philanthropic
arm of the telecommunications equipment giant, the prize offers $10
million (£6 million) to the successful designer of a handheld
device that integrates the latest in sensor and imaging
technologies with non-invasive laboratory tests and an
artificial-intelligence data engine, a device capable of diagnosing
15 different diseases in three days. About 250 companies or
individuals have pre-registered. By mid-2014 this list will be
winnowed down to the ten most technologically and medically
proficient concepts. A year later, the finalists will be announced,
based on the results of diagnostic testing, a "consumer experience
evaluation" and "proof of adequate high-frequency data
logging".

"In my BMW and plane I have 50 to 100 microprocessors watching
what's going on, generating data about all the critical
parameters," Diamandis says. "On the human, I have nothing. I have
a few bits of data I get on my annual physical. You should have
gigabytes of data, to identify well in advance of cancer and heart
attacks when something's off. This is where the future is going,
there's no question."

The list of the Tricorder X Prize applicants supports this.
Stephen Johnston, from the Biodesign Institute at Arizona State
University, has developed a finger-prick blood test that takes an
"antibody signature" to provide a wellness report and detect
diseases early. Michael Barnathan, the CTO of an AI startup
called Living
Discoveries, plans to build a device that integrates passive
data on everything from mammography to movement. Russian
researcher Igor Grakov has developed a cognitive test to determine
altered perception of colour -- imbalance is indicative of
changes to the autonomic nervous system and molecular biology: this
test is being utilised by UK firm Montague Healthcare. Another
startup, Lifecom Products, intends to combine individualised
sensors with advanced "decision support" to create an intermediate
agent that saves physicians from drowning in data. Like other
competitors, Lifecom CEO Steve Datena accepts that the intelligence
of his product may not matter unless he finds someone to partner
with. The breadth of the X Prize's goals appears designed to
encourage collaboration, so it's hard to gauge an early
front-runner.

Eugene Chan at work in his subterranean office in Cambridge, Massachusetts

Spencer Lowell

Eugene Chan has as good a chance as anybody of winning. In the
90s, he dropped out of Harvard Medical School to pursue an idea for
the fastest and cheapest personal genome decoder the world had ever
seen. Using a fluorescence-based sequencing technique, he believed
he had found a way to decode the variations in all three billion
base pairs of DNA in the human genome in 40 minutes. Chan raised
$20m to start a company, US Genomics; luminaries such as Craig
Venter marvelled at the possibilities and helped him raise a
further $30m. However, it changed its business model and scientific
focus several times, finally settling on pathogen detection.
Unhappy with the company's new direction, Chan returned to medical
school. One night, during a shift at Brigham and Women's Hospital
in Boston, Massachusetts, Chan saw a dying patient wait two hours
for test results. How could it be that in the 21st century one
couldn't get instant lab results? Thus began his journey into
medical diagnostics -- he wanted to change the way blood was
drawn. He applied to Nasa for funding and set up shop in Cambridge,
Massachusetts.

His Universal Blood Sensor (left) looks like an early mobile
phone and ejects a small blood-collector. The blood sample travels
through a tiny piece of plastic -- a "lab on a chip". Because the
sensor can conduct unlimited assays, Nasa commissioned a prototype
for the next generation of astronauts, who, if they make it to
Mars, will need to perform their own medical diagnosis.

The genome is unchanging; its information is primarily useful as a
predictive tool. But the information in blood is ever-changing or,
in medical parlance, "actionable". In clinical medicine, actionable
information beats static information every time. It could be
that Chan's epiphany at the hospital could have enormous impact on
medicine.

Diamandis's first X Prize, the Ansari, was awarded to the first
privately developed spacecraft to go into outer space -- Scaled
Composites' SpaceShipOne -- just eight years after the competition
was announced. Since then the X Prize Foundation has launched
competitions to sequence the genomes of centenarians, clean up oil
spills, put a robot on the Moon -- and create a Star
Trek-style Tricorder.

Before the idea for the Tricorder X Prize came about, Diamandis
sought advice from experts across disciplines. He talked to Larry
Brilliant, the doctor and technologist who worked with the World Health Organisation to
eradicate smallpox; and to David Ferrucci, the IBM employee who
built Watson, its AI natural-language processor. But the most
interesting conversation Diamandis had was with a marketing
executive in Qualcomm's Health amd Life Sciences group named Don
Jones.

Diamandis approached Jones about an earlier idea for a medical X
Prize that he thought Qualcomm might want to sponsor. The idea was
to combine AI with smartphone technology to create an "AI
Physician" that could make a diagnosis by combing through a
patient's medical history and asking questions. "It's projected
that, by the year 2020, the US will be short of 91,000 doctors,"
Diamandis tells Wired. "But that shortage is good compared to the
rest of world. Take Africa. It has 25 per cent of the world's
disease burden but has only 1.3 per cent of the world's healthcare
workers." Diamandis's goal was to provide a doctor for every human
being on Earth.

Jones told Diamandis that Qualcomm might be interested, but,
"Would be much more interested in a solution incorporating more
data points than could be provided by software and queries," Jones
recalls. Wireless sensors, imaging technology and medical equipment
were advancing fast, and Qualcomm saw in them huge opportunities
for advancing global health. In thousands of laboratories across
the world, scientists were creating a new generation of medical
tests so minimally invasive that they could soon be partnered with
wireless technology. Generating an infinite stream of real-time
information about every cellular function imaginable, our bodies
would become living, breathing data centres.

"There's a good working example of this," Jones says. "Diabetes.
Forty years ago if you were diagnosed with diabetes you had to go
to the doctor's office and get your glucose measured and your
insulin dosage adjusted." But with the advent of glucometers,
patients can do these things themselves. Self-testing revealed new
details about how diet, exercise and stress affected glucose
levels. Fifty years after the invention of the glucometer,
diabetics remain a rare patient group that can manage their health
in real-time. The rest of us rely on metrics such as our body
temperatures.

Jones believed that even healthy people should be able to have
access to the sort of data available to diabetics. He told
Diamandis that Qualcomm would be interested in sponsoring an X
Prize that incorporated AI and remote sensoring and diagnostics, a
prize that offered not only the possibility of self-diagnosis, but
of data management and analysis. Following further development of
the concept, the Qualcomm Foundation formally became sponsor of the
Qualcomm Tricorder X Prize.

The De Brouwers

Nelson (left) and his father Walter in the Bay Area, San Francisco, May 2012

Spencer Lowell

But convincing people that they not only have the right to the
information within their bodies, but the knowledge to manage it, is
challenging. "There's a great danger in saying healthcare
information should be the same as [online] banking. There are so
many variables," says Leslie Beard, the manager for the Centre for
Innovation in Complex Care, a division of the University of Toronto
Faculty of Medicine. Even Harvard chemist George Whitesides, whose
work miniaturising diagnostic tests on to squares of paper is being
used by the company Diagnostics for All to proliferate cheap
medicine throughout the developing world, admits the notion of
healthcare's intrinsic "differentness" has merit. "You have
something called a 'patient', who you need to get something
physical from," he says. "A drop of blood. Urine. You have to think
about privacy. You have to think about discomfort."

When Diamandis announced the Ansari X Prize back in 1996,
not only was it was illegal in the US to send a commercial rocket
into space, there was no regulatory authority for such an idea.
Diamandis had to ask Nasa and the Federal Aviation Authority to
create one. The Qualcomm Tricorder X Prize faces similar
challenges.

There are also regulatory hurdles confronting the Tricorder X
Prize. In the US, the Food and Drug Administration (FDA) plays a
czar-like role in dictating which medical technologies enter the
marketplace. When Jones and Diamandis finalised the Tricorder
concept, they made sure to contact the FDA. "There's never been a
device this complex," Jones says. "But the actual prize doesn't
require a commercialised, FDA-approved product. Just one that
works."

Do you really want unmitigated, real-time access to your body's
data? Might it create a population of unfathomably
detail-orientated hypochondriacs? Could information be a gift or a
curse? Will doctors become mere intermediaries between our bodies
and machines? Instead of six years of training, will they require
six months?

De Brouwer thinks a lot about such questions. He views Scanadu
as part of the digital era's three-pronged information revolution.
This first goal is to create citizen doctors. Then, perhaps, he'll
turn his attention to government and then education. A concern,
however, is whether Scanadu might become another Starlab. The
company was started with an initial $2m in seed funding, and has
continued to attract investors. By the end of 2013, it aims to have
taken three products to market. However, some VCs find Scanadu
challenging due to its plan for a multi-pronged product line:
Tricorders for the medical establishment, for consumers,
paediatrics and parents. Scanadu's business model has evolved to
target "spit and polish" Tricorders that aim to execute existing
ideas better, such as measuring physiological traits (Scanadu
SCOUT), testing for upper respiratory infections (Project ScanaFlu)
and checking urine for diabetes, kidney failure and pregnancy
(Project ScanaFlo).

"Diagnosis is a 20th-century word, it's
obsolete"

Walter De Brouwer

But whereas Starlab was a patent farm, Scanadu is manufacturing
products; whereas Starlab believed anything was possible, Scanadu
has a discerning attitude towards new technologies; whereas Starlab
was headquartered in a former embassy building on the outskirts of
Brussels, Scanadu rents space in a former naval barracks on the
campus of Nasa Ames Research Center, down the street from
Singularity University. And whereas Starlab was the creation of
unbridled optimism, Scanadu was set up by a man who seems to have
learned from his mistakes. De Brouwer knows Scanadu is a tough
sell. Investors love to throw money at single-purpose technologies
that come out of storied institutions and can do one large market
test reliably. But Scanadu is, as yet, unproven in the market.

On the day Wired was supposed to meet him last summer, De
Brouwer had a heart scare, prompting Scanadu's medical consultant,
Jamison Feramisco, to run an ECG with a prototype of the Scanadu
SCOUT. De Brouwer caught a flight back to Belgium for a proper
check-up, as he has no US health insurance. When he returned to the
US, Wired met him at his house in Los Altos, California. He was
alone, sitting on a sofa in front of an enormous flat-screen TV
that took up an entire wall. There was no other furniture. He was
unshaven, and he was wearing black sunglasses.

In Belgium, the doctor had given De Brouwer an ultrasound and a
cardiac stress test. If a middle-age heart scare typically instills
the fear of advancing age, for De Brouwer it only affirmed what he
already believed: that the advice dispensed by doctors, otherwise
known as a "diagnosis", was not nearly as valuable as most people
think. "He puts me on the machine, puts on the gel, takes the
ultrasound," De Brouwer says mockingly. "And all he says is, 'Yep,
yep, OK, yep…'"

These days, his son Nelson has problems with syntax and
universal knowledge, and the right side of his body is paralysed.
When De Brouwer was in the ICU, he made a discovery that deepened
his conviction about why medicine will undergo radical change.
There were other children in the ICU, and De Brouwer realised that
the only way he could be useful -- either to Nelson or himself --
was to indulge a kind of therapeutic energy by trying to help the
parents. The strangers traded tips and tricks about the
significance of the machines' oxygenation readouts, about what to
do in case of a blood clot. They created a network. "I forgot
my own situation," he says. "Helping is therapeutic, it helps you
forget your own misery.

"Diagnosis is a 20th-century word, it's obsolete," he says. "A
carbon-based unit with a degree and residency duty has pronounced a
verdict protected by a community of brethren about a number of
government-audited procedures that have been documented by the
pharmaceutical industry. The new word is 'recommendation'. If
my child is sick, I want to compare him to other children with the
same illness. And then I will talk to a doctor, if necessary."

Like many X Prize competitors, Scanadu is building on existing
technology, while developing proprietary tech (with a claimed 38
patents at time of press), diagnostic algorithms and
techniques such as hyperspectral imaging in diagnosis. Can all this
bring us a step closer to a Star Trek future, where data
is the doctor? We can't be sure, but someone has to boldly go
there.